Haishu Ding

Research on the relationship between brain anoxia at different regional oxygen saturations and brain damage using near-infrared spectroscopy

The objective of this paper is to investigate the difference in physiological parameters, EEG and morphology of brain tissues in newborn pigs with different regional oxygen saturations of brain (rSO(2)) and provide a basis for the determination of brain injury and degree of injury with the rSO(2) in clinical practice. A noninvasive near-infrared spectroscopy (NIRS) technique was used to monitor the rSO(2) of 27 newborn pigs. After mechanical ventilation and inhalation of 3-11% oxygen for 30 min by the newborn pigs, the pigs were grouped according to the rSO(2) in the brain caused by inhalation of different concentrations of oxygen. There were six animals each in rSO(2) < 30%, 30-35%, 35-40%, 40-50% groups and three animals in the rSO(2) > 60% group (normal control). The physiological parameters and the EEG were monitored during the experiment. The animals were sacrificed by decollation at 72 hours after brain injury, and light microscope examination and pathological analysis of the ultrastructure were conducted on the brain tissues in the CA1 zone of hippocampi. In rSO(2) > 40% groups, the mean arterial pressure (MAP) was stable and there were no significant changes in blood lactic acid, amplitudes of the EEG, light microscopic findings and ultrastructure after hypoxia. When the rSO(2) was between 30% and 40%, the MAP was stable, the level of blood lactic acid increased, metabolic acidosis occurred, there was no significant change in the amplitudes of the EEG, there were ischemic changes in brain tissues under a light microscope and there was an injury of mitochondria in the neurons in the CA1 zone of hippocampi. When the rSO(2) was less than 30%, circulatory failure occurred, the level of blood lactic acid increased, there was serious metabolic acidosis, the amplitudes of the EEG significantly decreased, there were vacuolization and broken fragments of cells under the light microscope and the mitochondria in the neurons in the CA1 zone of hippocampi were seriously injured. Under varying degrees of hypoxia, when the rSO(2) is between 30% and 40%, brain injury occurs and the functional zones of mitochondria are injured in newborn pigs. When the rSO(2) is less than 30%, the brain functions are seriously abnormal, and the serious morphological impairment in the functional zones of mitochondria is the basis for the disturbance of energy metabolism in brain neurocytes after hypoxia and the sequelae of the nervous system.

Assessment of the hypoxic-ischemic encephalopathy in neonates using non-invasive near-infrared spectroscopy

This paper introduces a method of monitoring cerebral oxygenation for healthy neonates and neonates with hypoxic-ischemic encephalopathy (HIE) using near-infrared spectroscopy. The object of this study was to investigate whether or not there were differences between the HIE group and the healthy group in terms of NIRS parameters. The subjects were all term neonates, their age ranging from 2 to 18 days. The healthy group included 25 subjects while the HIE group consisted of 16 patients. A prototype NIRS instrument, which provides the data of tissue oxygenation including regional oxygen saturation (rSO2), the increment of oxyhemoglobin concentration and hemoglobin (deltaHbO2 and deltaHb) was used, and the data of rSO2 was compared with the data from the blood gas analyzer. The result shows that: (1) the mean+/-SD of rSO2 for the healthy group was 62 +/- 4% in the frontal region under the quiet sleep condition, but the mean+/-SD of rSO2 for the HIE group was 53 +/- 3%. (2) As all subjects inhaled pure oxygen in 21 min(-1) for a period of 60 s, rSO2 for the healthy group increased rapidly, with the increase in rSO2 (deltarSO2) being 7 +/- 2.3%, but the increase in rSO2 for the HIE neonates was 3 +/- 1.5%. After inhaling oxygen, deltaHbO2 and deltaHb between the two groups were also significantly different. (3) During all the experiments SpO2 was monitored, the value of SpO2 was not significantly different between the two groups. The above observations suggest that the rSO2 in quiet condition and the values of change of rSO2, HbO2 and Hb during the inhalation of oxygen may be used as the parameters to discover and assess the HIE infants.

Neurodevelopment in newborns: a sample entropy analysis of electroencephalogram.

The present paper investigates the neural ontogeny of newborns in view of electroencephalogram (EEG) complexity during active sleep (AS) and quiet sleep (QS). Sample entropy (SampEn) is applied to EEG recordings from 168 newborns with postmenstrual age (PMA) ranging from 25 to 60 weeks. The relationship between neurodevelopment and PMA is then explored according to the statistical analysis of the median and interquartile range of SampEn curves. It is found that SampEn of EEG during AS is higher than that during QS. SampEn increases during both AS and QS before about 42 weeks in PMA while it ceases its increase in QS and even decreases in AS after newborns reaching term age. A distinct decrease in the interquartile range of SampEn is found with increasing PMA (from 25 to about 50 weeks), followed by maintenance of low fluctuation in SampEn curves. The study in this paper sets the stage for exhaustive investigation of the SampEn of EEG during brain maturation in newborns. And it could be hoped that SampEn in sleep EEG might be a useful parameter against which delays and aberrations in brain maturation might be tested. The SampEn changes during brain maturation also offer functional clues about neurodevelopment, based on which further explorations could be done. The significance of this paper is the discovery of the decrease in EEG complexity after newborns reaching term. Although some potential neurophysiologic reasons are given, this new discovery might require more study to investigate. In addition, the fluctuation of EEG complexity is analyzed for the first time, which helps to understand the EEG maturation in neurodevelopment.

Assessment of blood and oxygen delivery to flaps of rhesus using near infrared steady-state spectroscopy

Near infrared spectroscopy has been considered as a potentially ideal noninvasive technique for the postoperative monitoring of plastic surgery. In this study, 6 flaps were raised on rhesus monkeys’ forearms. Blood and oxygen delivery to these flaps was monitored following vascular occlusions and inhalation of pure oxygen. Optical fibers were adopted in the probe of the oximeter so that the cutaneous detection could be performed in reflectance mode. Different and repeatable patterns of changes were measured following vascular occlusions on flaps. It is clear that the near infrared spectroscopy is capable of postoperatively monitoring vascular problems in flaps, especially the venous problem. Near infrared spectroscopy showed high sensitivity to detect the dynamic changes in flaps induced by inhalation of pure oxygen in this study. The experimental results indicated that it was potential to assess tissue viability utilizing the dynamic changes induced by some noninvasive stimulation (such as inhaling pure oxygen). It may be a new assessing method that is rapid, little influenced by other factors and less inconvenient to patients.

Physiological meaning of cerebral oxygen saturation for piglet with hypoxia-ischemia

The physiological meaning of cerebral oxygen saturation absolute values and the oxygen metabolism of piglet with hypoxia-ischemia (HIE) were researched. The subjects were two piglets. During the total experiment of hypoxia then recovery, the regional cerebral tissue oxygen (rScO2), pulse oxygen saturation (SpO2) were detected non-invasively and the jugular oxygen saturation (SjO2), arterial oxygen saturation (SaO2) were given invasively. The results show that because SjO2 was equal to or larger than rScO2 and SaO2 > ScO2, rScO2 cannot be determined by the weighted sum of SjO2 and SaO2 which had been presented in some papers. According to above-mentioned analysis, the ecchymoma and pathological changes of the vessels due to HIE may be another contribution of rScO2. SjO2 was correlated with SaO2 (R=0.996 and 0.962 for two piglets) and the values of (SaO2-SjO2) are close to constants (29.3±8% and 30.3±8%).It means that because the subjects were under anesthesia, the oxygen consumption of cerebral tissue kept constants.

Using noninvasive NIRS to evaluate the metabolic capability of infant brain

The value of cerebral oxygenation saturation is important for optimal treatment and prognosis in neonates during perinatal period. The purpose of this study was to investigate the cerebral oxygen in newborn infants and obtain clinical characteristic parameters by using steady state spatially resolved near infrared spectroscopy. The subjects consist of 239 infants selected from two hospital. The results show that the values of regional cerebral oxygen saturation (rSO2) for preterm infants with gestational ages of 27 - 32 weeks were different from term infants and the value of rSO2 for sick term infants after treatment were better than that of before treatment. Above results suggest that the value of rSO2 may be used as a clinical parameter to assess cerebral oxygen for preterm and sick infants avoiding hypoxia.